Health

Scoliosis Discovered Late In Life

Dear Dr. Pat,

I am 60 years old and recently noticed that my clothes seemed to no longer fit properly.  I exercise, I am the weight I have always been as an adult, so I found this change to be odd. I took some clothes to a tailor who was European. He explained that I had developed a slight curve in my spine that was affecting sleeve length on one side and that my shoulder and hip on one side were both higher than on the other side.  Obviously this unfortunate occurrence had occurred so slowly over time that I had not noticed. After this diagnosis from the tailor, I made an appointment to see a spine specialist who confirmed that the tailor was right. I have scoliosis. Why wasn’t this diagnosed before? Why did it happen? What can I do about it? Now, every older woman I see who has a stooped posture with a curved spine sends me into panic attacks. Please discuss this problem that seems to be far more prevalent than I knew.

Carla

 

Dear Carla,

Scoliosis diagnosed in an adult for the first time is nearly always subtle early on. Patients may complain of back pain and the diagnosis of scoliosis may be made as part of the evaluation.  Other patients may not have pain but the diagnosis is determined by a physical exam. In your case, diagnosis came from a very knowledgeable tailor! Muscle spasm and poor ergonomic design of how we sit at work may over time affect the shape of the spine as we do the kind of work so many of us do: interviewing people, taking meetings, slaving over the computer, often with legs crossed and not sitting back on the tailbone the way we should. When I examine patients, I include an exam of the spine and often discover exactly what you describe: one side of the body will have an elevation in a shoulder and hip with subsequent alteration in waist and over time, a change in rib cage anatomy and even a tummy pooch that is not related to fat.

Dr. James Wyss, an assistant Attending Physiatrist in the Department of Physiatry at the Hospital for Special Surgery in New York City and a member of our Medical Advisory Board will discuss scoliosis more thoroughly over the next two Medical Monday posts. Today’s post will cover the basic aspects of scoliosis; the second will go over its medical management.  Thanks for writing to us about this common condition.

Dr. Pat

 

Response from Dr. James Wyss

As a physiatrist I treat many conditions, including scoliosis, that impact mobility and function in teenagers and adults. When patients come to my office with a known history of scoliosis, their stories vary a great deal. Some recall exactly when they were diagnosed and what treatment they received as a child or teenager. Others only recall being told, “You have a mild curvature of the spine, don’t worry about it.” Some adults come to my office explaining that they have recently been diagnosed with scoliosis, and others are diagnosed with scoliosis at the end of my physical and X-ray examination of their spine.

 

What Is Scoliosis?

Scoliosis is a lateral (side-to-side) curvature of the spine.  The Scoliosis Research Society defines scoliosis as a lateral curvature that is greater than 10 degrees. Several factors help to describe the location, side, shape, and severity of the curvature.

SCImages 1A and 2A show normal alignment of vertebrae versus scoliosis. (Source: Scoliosis Research Society)

 

Location: The mid-back (thoracic spine) is the most common location of scoliosis. The thoracic spine has attachment sites for the ribs; therefore, curvatures of the thoracic spine cause asymmetries of the ribs—often described as a rib hump.

Side: Either right or left— determined by the side of the convexity to which the curvature commonly points; the most common type is located on the right side in the thoracic spine.

Shape: S-shaped or C-shaped. S-shaped scoliosis has two curves that face opposite sides, usually with a primary (or larger) curve. C-shaped scoliosis has a curve to only one side.

Severity or degree of curvature: Finally, and possibly most important, scoliosis is defined by the degree or severity of the curve. The vast majority of scoliotic curves are considered to be mild (11 to 20 degrees). This is important because many decisions regarding treatment are based on the severity of the curvature, especially during adolescence.

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  • Susanna Gaertner April 30, 2018 at 1:28 pm

    Pilates helps in countering the effects/onset on scoliosis: by stretch and strengthening the pelvic plate from the inside you can avoid or at least forestall that bottom-under curl that begins to weaken the spine into curvature.
    pilates4all dot com
    Spine health is key!

    Reply